CIGNA

[To assist us in bringing this matter to a close, you must give us a reason why you are rejecting the responseIf no reason is received your complaint will be closed Administratively Resolved] Complaint: ***I am rejecting this response because:
No effort was made on the part of Cigna to resolve the issue (I have received nothing from them and have had no communication from Cigna on this matter), poor communication on the part of Cigna regarding policy details prior to enrollment and their desire to take the premiums but provide little to no service is unacceptable. I am considering terminating my business with Cigna. I encourage others to consider my experience before signing up with Cigna Dental InsuranceRegards,*** ***

Hello-
Thank you for sharing this complaintI have reviewed the customer's concerns and show a letter was mailed to the customer at the address on file on October 31, A copy of this letter will be remailed today, November 25,
Thank you
Tanya H***
Cigna's Executive Office Advocacy Team

Acknowledgement Letter along with Authorization for Disclosure of Protected Health Information form sent to customer on 02/14/2017.Pamela D***Executive Office Advocacy Team

Acknowledgement Letter along with Authorization for Disclosure of Protected Health Information form sent to customer on 02/14/2017. Charlene V***Executive Office Advocacy Team

October 29, Dear *** ***,This will acknowledge receipt of your letter dated October 27, regarding the above captioned matter, which was received in our office today.We have forwarded this matter to the appropriate area for research and response.Please be assured that you will be contacted as soon as the accountable area has had an opportunity to conduct the necessary research in response to your inquiryWe will respond to your inquiry as soon as possible but no later than the due date provided in your letterIf our research or response efforts are delayed for any reason, we will let you know.Meanwhile, should you have any questions, please contact me directly at ###-###-####Sincerely,
Rick P
Consumer Advocacy Specialist

Thank you for this informationI will be in review of this issues and will respond directly to the customerThank you,
Nicole P***

We
are writing to acknowledge and respond to your correspondence dated
April 1, 2016, regarding Joey ***’s claim for Long Term
Disability (LTD) benefitsMr*** was covered under his employer
provided, fully-insured LTD policy ** ***, which was underwritten
by Life Insurance Company of
North America (***) and issued in
Georgia.Mr
*** raised concerns regarding his most recent LTD claim experience
and claim decisionPlease allow us this opportunity to address his
concerns and explain our decisionWith
respect to Mr*** employer’s LTD policy ** ***, in order for
benefits to be payable, his medical records needed to support that
his health conditions caused a functional impairment that would
continuously meet the following definition of Disability/Disabled to
be eligible for benefits:Definition
of Disability/DisabledThe
Employee is considered Disabled if, solely because of Injury or
Sickness, he or she is:unable
to perform the material duties of his or her Regular Occupation; andunable
to earn 80% or more of his or her Indexed Earnings from working in
his or her Regular OccupationAfter
Disability Benefits have been payable for months, the Employee is
considered Disabled if, solely due to Injury or Sickness, he or she
is:1)
unable to perform the material duties of any occupation for which he
or she is, or may reasonably become, qualified based on education,
training or experience; and2)
unable to earn 60% or more of his or her Indexed Earnings.The
Insurance Company will require proof of earnings and continued
Disability.While
his LTD benefits were approved for a time, continued LTD benefits
were not payable to Mr*** beyond October 29, 2014, because he no
longer met the policy’s definition of DisabilityBenefits were
subsequently paid through this date and then discontinuedAccording
to our records, this determination was also reviewed and upheld
through two separate administrative appealsWhile we understand Mr
*** disagrees with our determination and paid for coverage under
policy ** ***, further LTD benefits would only be payable if a
continued functional impairment was supportedAt this time, it has
been determined that Mr*** did not meet this definition of
Disability/Disabled beyond October 29, as required by his
employer’s policyBased on our review, no further financial
compensation is due to Mr*** at this timeShould
you have any questions or would like to discuss this matter further,
please feel free to contact me directly at ###-###-####.Sincerely,Eric
F*,Compliance
SpecialistCGI
Consumer Advocacy

January 6, 2016Dear Sir or Madam:We are writing in response to your correspondence received on December 29, 2015, referencing *** *** ***' claim for Short Term Disability (STD) benefits*** *** was covered under his employer self-funded STD group benefit plan ***This plan
was administered by *** *** *** ** *** *** (***).*** *** raised concerns regarding his most recent STD claim experience and customer service issuesCustomer service is extremely important to us and we have communicated this information to the appropriate management to be addressedPlease allow us this opportunity to address his concerns, explain our decision, and provide an updated status of his claim.With respect to *** *** employer's STD plan ***, in order for benefits to be payable, his medical records needed to support that his health conditions caused a functional impairment that would continuously prohibit him from performing the material duties of his own occupationThe policy's “Definition of Disability/Disabled” as:The Employee is considered Disabled if, solely because of Injury or Sickness, he or she is: unable to perform the material duties of his or her Regular Occupation, and unable to earn 80% or more of his or her Covered Earnings from working in his or her Regular Occupation.While his STD benefits were approved for a time, continued STD benefits were not payable to *** *** beyond November 30, 2015, because he no longer met the policy's definition of DisabilityThis determination was based on our ongoing medical review of the relatively stable findings and imaging reports received from his providersAfter a complete medical review of the available records on file, it was determined that *** ***' condition would not render him Disabled beyond the date referenced above, according to the terms of his STD planAs a result, no further benefits were payable and his claim was closedOn December 11, 2015, a letter was sent to *** ***, which explained our decision and further explained the appeal process.Subsequent to our decision, *** *** requested that his Claim Manager request further medical documentation from his treating providers to be consideredAlthough this is not our standard process, on December and December 15,2015, our claims department sent requests for updated information to *** ***’ treating providersUpon receiving this updated documentation and reviewing it with our medical experts, it was determined that *** *** would be unable to perform the duties of his Regular Occupation and on January 5,2016, his STD benefits were reinstated,At this time, *** ***’ STD claim remains active as he continues to be eligible for STD benefitsShould he have any questions regarding his STD claim status or payment he can contact his new Claim Manager, Andrew W., directly at ###-###-#### for further assistance.Thank you for allowing us this opportunity to respond to your inquiry regarding *** ***’ STD claimWe hope the information provided is helpfulShould you have questions or would like to discuss this matter, please do not hesitate to contact me directly at ###-###-####You may also contact CGI’s Consumer Advocacy department regarding any group disability, life or accident concerns at:Cigna Consumer AdvocacyAttn: Meredith *L*** *** *** ***Phoenix, AZ ***Email: [email protected]: ###-###-####Sincerely,Rick P.Consumer Advocacy Specialist

Thank you for this information
I sent an acknowledgement letter to *** *** on June 9, 2016, and complaint resolution correspondence was sent to the customer on June 20, 2016.
Thank you,
Rae B***

Thank you for forwarding this complaint to CignaCigna has reviewed this complaint and resolution has been met with customerCustomer is satisfied.Erica M***Executive Office Advocacy Team

Thank you for this informationI will be in review of this issue and will respond directly to the customer.Thank you,Nicole P***

[To assist us in bringing this matter to a close, you must give us a reason why you are rejecting the responseIf no reason is received your complaint will be closed
Administratively Resolved]
Complaint: ***
I am rejecting this response because:The specialist who reviewed my complaint did not read it correctlyI was talking about the site being misleading and making me believe I can use my MRA fund for dental reimbursementShe responded about reviewing a phone call; that's not what I asked to be reviewedI will add attachments of the misleading information on the website to make it clearer
Regards,
*** ***

Thank you for this information. I will research and respond directly to the customer
Thanks,
*** ***

Good morning,
Cigna's Executive Office of Complaints has received the complaint and will be following up with the customer for resolution
Thank You,
Rafael P

Hello,
Thank you for this informationI will be in review of the issue and will contact the customer directlyThank you,
Nicole P***

Received:Apr 18, 05:06:PMExpires:Jun 17, 05:06:PMFrom:*** *** ***To:***Subject:Revdex.com Complaint ID: ***Good Evening *** ***,Thank you for this informationCigna has reviewed and acknowledged this complaintI can confirm a resolution letter was sent to the customer on April 18, 2017, outlining the steps Cigna has taken to resolve her issues. Travis C***Executive Office Advocacy Team

Hello-
Thank you for forwarding this customer's complaintCigna will review and folldirectly with the customerThank youTanya H***

Thank you for this information.This issue has been reviewed and communication sent to the customer directly.Thank you,Nicole P***

Hello,
Cigna's Executive Office Advocacy Team has received *** ***'s complaint and will be taking action to further investigate and rectify the situationWe will follow up directly with the customerThank You,
Rafael P***

There are no recordings that confirm the customer was advised to seek the services rendered and the claim cannot be reprocessed.Thanks,ChiffonChristin Chiffon B***Executive Office Advocacy Manager-Customer Satisfaction